Abstract
The importance of cryptorchidism treatment concerns the possibility of diminishing risk of malignant degeneration and improving fertility. Success rates of hormonal treatment vary: 0–55%with human chorionic gonadotropin (hCG) and 9–78% with gonadotropin-releasing hormone (GnRH). Due to uncertainties regarding the effectiveness of this treatment, a systematic review and meta-analysis of randomized controlled trials (RCTs) on hormonal cryptorchidism treatment was done using the methodology of Cochrane Collaboration. Two studies compared hCG with GnRH, with a testicular descent rate of 25% vs. 18%, respectively. Nine trials compared intranasal LHRH with placebo, with complete testicular descent rates of 19% vs. 5%. Two other studies comparing doses and administration intervals could not be pooled together due to heterogeneity. With the information analyzed until the present, the evidence for the use of hCG vs. GnRH shows advantages for hCG, and this review also shows that there is evidence that luteinizing hormone releasing hormone (LHRH) is more effective than placebo. But because this evidence is based on few trials, with small sample sizes and moderated risk of bias, this treatment cannot be recommended for everyone, and there is no evidence that supports hCG’s use in larger doses and larger intervals. Results from this systematic review are important for developing better RCTs that may decrease the uncertainty of cryptorchidism treatment.
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References
Martin DC (1979) Germinal cell tumors of the testis after orchiopexy. J Urol 121:422–424
Pottern LM, Brown LM, Hoover RN (1985) Testicular cancer risk among young men. J Nat Canc Institut 74:377–381
Pyörälä S, HuttunenNP, Uhari M (1995) A review and meta-analysis of hormonal treatment of cryptorchidism. J Clin Endocr Metabol 80:2795–2799
Christiansen P, Müller J, Buhl S, et al. (1988) Treatment of cryptorchidism with human gonadotropin or gonadotropin hormone. Horm Res 30:187-192
Gross RE, Jewett JR (1956) Surgical experiences from 1222 operations for undescended testis. JAMA 25:634–641
Egger M, Davey-Smith G (1995) Misleading meta-analysis. BMJ 310:752–754
Rajfer J, Handelsman DJ, Swerdoloff RS, et al. (1986) Hormonal therapy of cryptorchidism. A randomized, double-blind study comparing human chorionic gonadotropin and gonadotropin- releasing hormone. N Engl J Med 314:466–470
Christiansen P, Müller J, Buhl S, et al. (1992) Hormonal treatment of cryptorchidism: hCG or GnRH—a multicentre study. Acta Paediatr 81:605–608
Illig R, Kollmann F, Borkenstein M, et al. (1977) Treatment of cryptorchidism intranasal synthetic lutenising-hormone releasing hormone. Lancet 10:518–520
Illig R, Torrasani T, Bucher H, et al. (1980) Effect of intranasal LHRH therapy on plasma LH, FSH and testosterone, and relation to clinical results in prepubertal boys with cryptorchidism. Clin Endocrinol 12:91–97
Karpe B, Eneroth P, Ritzén M (1983) LHRH treatment in unilateral cryptorchidism: effect on testicular descent and hormonal response. J Pediatr 892–896
Klidjian AM, Swift PGF, Jonhstone JMS (1985) LHRH for incomplete descent of the testis. Arch Dis Child 60:528–571
Wit JM, Delemarre-Van de Waal HA, Bax NMA, Van Den Brande JL (1986) Effect of LHRH treatment on testicular descent and hormonal response in cryptorchidism. Clin Endocrinol 24:539–548
De Muinck Keizer-Schrama SM (1988) Hormonal treatment of cryptorchidism. Horm Res 30:178–186
Hagberg S, Westphal O (1987) Results of combined hormonal and surgical treatment for undescended testis in boys under 3 years of age. Eur J Pediatr 2:S38-S39
Olsen LH, Genster HG, Mosegaard A, et al. (1992) Management of the non-descended testis: doubt value of luteinizing-hormone-releasing-hormone (LHRH). A double-blind, placebo-controlled multicentre study. Int J Androl 15:135–143
Bica DTG, Hadziselimovic F (1993) The behavior of epididymis, processus vaginalis and testicular descent in cryptorchid boys treated with buserelin. Eur J Pediatr 152:S38-S42
Forest MG, David M, David L, et al. (1988) Undescended testis: comparison of two protocols of treatment with human gonadotropin. Horm Res 30:198–206
Hesse V, Fischer G (1988) Three injections of human chorionic gonadotropin are as effective as ten injections in the treatment of cryptorchidism. Horm Res 30:193–197
Del Nero RGM, Atallah AN (1999) Therapeutic scheme (doses, and intervals of administration) with hCG in cryptorchidism: systematic review. Thesis, São Paulo Federal University
Eysenck HJ (1995) Problems with meta-analysis. In: Chalmers I, Altman DG (eds) Systematic reviews. BMJ, London, pp 67–74
Schulz KF, Chalmers I, Hayes RJ, Altman DC (1995) Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 273:408–412
Thorup J, Kvist N, Larsen P, Mauritzen K (1988) Clinical results of early and late operative correction of undescended testes. Br J Urol 56:322–325
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Henna, M.R., Del Nero, R.G.M., Zugaiar S. Sampaio, C. et al. Hormonal cryptorchidism therapy: systematic review with metanalysis of randomized clinical trials. Ped Surgery Int 20, 357–359 (2004). https://doi.org/10.1007/s00383-004-1198-3
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DOI: https://doi.org/10.1007/s00383-004-1198-3